[Psychopathology and phenomenology of religious delusion of possession in schizophrenia]

The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help-seeking attitudes: A narrative review

AIM

Culture has been posited to be involved in the formation and maintenance of delusions and hallucinations. The extent of these differences and how they affect explanatory models of psychosis and help-seeking attitudes remains to be understood. This review aims to present a cultural formulation to account for psychosis onset, symptom maintenance, and help-seeking attitudes.

METHODS

A narrative review was conducted to summarize the existing evidence base regarding cross-cultural differences in hallucinatory and delusional prevalence, explanatory models, and help-seeking attitudes in First Episode Psychosis (FEP) and Non-FEP Schizophrenia samples.

RESULTS

Sixteen studies were eligible for inclusion. In terms of positive symptom specificity, cross-cultural differences were found. Specifically, auditory and visual hallucinations occurred most frequently in African patients, persecutory and grandiose delusions occurred at higher rates in African, Pakistani, and Latino patients, while delusions of reference were most prevalent in White-British groups. Three explanatory models were identified. Westerners tended to endorse a bio-psychosocial explanation, which was associated with increased help-seeking, engagement, and positive medication attitudes. Asian, Latino, Polish, and Māori patients endorsed religious-spiritual explanatory models, while African patients opted for a bewitchment model. The religious-spiritual and bewitchment models were associated with a longer duration of untreated psychosis (DUP) and poorer engagement with mental health services.

CONCLUSIONS

These findings highlight the important influence of culture in the formation and maintenance of positive symptoms of psychosis, engagement, and help-seeking attitudes across different ethnic groups. The incorporation of cultural beliefs in formulation development could facilitate enriched CBTp practices and improved engagement amongst different cultural groups with Early Intervention Services.

Dynamics of views on different aspects of schizophrenia (Narrative Literature Review)

Как известно, шизофрения остается во многом неясным психическим расстройством, являющимся значительным социальным и экономическим бременем. Поэтому обзоры литературы, охватывающие основные аспекты этиологии, диагностики и диагностических ошибок в разные временные периоды, представляются актуальными. В статье приведены данные анализа более 200 отечественных и зарубежных работ по указанным аспектам шизофрении, преимущественно за последние 10 лет, а также имеющих важное историческое значение. Обзор литературы по вопросам этиологии и диагностики шизофрении может способствовать вниманию ученых к тем или иным результатам исследований на новом концептуальном и методическом этапе. При этом качественные изменения в понимании шизофрении и расстройств шизофренического спектра способствуют развитию инновационных технологий в психиатрии, что важно для науки и практики данной дисциплины.

[Doomsday delusions of religious content (apocalyptic version)]

OBJECTIVE

To define psychopathological and phenomenological characteristics of the apocalyptic variant of end-world delusion with religious content (EWDRC) in schizophrenia, to identify features of clinical dynamics of delusional disorders and their interaction with delusional behavior of patients.

MATERIAL AND METHODS

A total of 28 patients with schizophrenia (F20.01, F20.02 according to ICD-10) and EWDRC were examined. Clinical-psychopathological and follow-up methods were used.

RESULTS

The development of the end-world delusional ideas occurred in unstructured affective-delusional disorder with acute sensual delusion. Two types of EWDRC were differentiated: with predominance of perception delusion or picturesque delusion. These types differed by acuity and massiveness of psychotic symptomatology, the mono- or polythematic character of delusional disorders, affect type, as well as by the duration and intensity of the development of delusional stages, and in their phenomenological specifics.

CONCLUSION

Delusional ideas of the end of the world in schizophrenic patients develop in the structure of the syndrome of acute sensory delusions with a predominance of delusions of perception (type I) or visual-figurative delusions of the imagination (type II), which have different duration, degree of dominance and depth of psychopathological disorders.

Delusions of Possession and Religious Coping in Schizophrenia: A Qualitative Study of Four Cases

The notion of evil spirits influencing human behavior or mental processes is used in many cultures to justify various symptoms or experiences. It is also expressed in psychotic delusions of possession, but there is limited research in this area. This study explores how patients with schizophrenia came to the conclusion that they were possessed, and how this affected help-seeking. Interviews with two men and two women about their experiences and meaning-making were subjected to interpretative phenomenological analysis. Three main themes were identified: (1) Links between traumatic experiences and psychotic symptoms, (2) The emergence of religious themes in delusional contents, and (3) Reluctance to use medical treatment and instead to seek exorcism. In each case, attributing problems to possession was supported by the local environment and media, led to seeking spiritual help, and delayed diagnostic assessment and treatment. However, using religious coping contributed to the sense of predictability and social support. Clinicians are encouraged to explore the experiences and conflicts expressed by the symptoms which people ascribe to possession and to negotiate alternative explanatory models with their patients.